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1.  Environmental Toxins: Physical, Social, and Emotional 
Breastfeeding Medicine  2010;5(5):223-224.
doi:10.1089/bfm.2010.0050
PMCID: PMC2966478  PMID: 20942704
2.  INADEQUATE: A Metaphor for the Lives of Low-Income Women? 
Exclusive breastfeeding of infants for the first six months of life with continued breastfeeding for at least six more months occurs only 11.9% of the time in the US. Efforts of the past 30 years to promote optimal breastfeeding practices have had little impact. In order to create significant change in the way we feed infants in this country, we need to change the way we look at this public health issue and examine the cultural logic that makes bottle feeding the preferred choice of most US women. This paper analyzes the term ‘inadequate’ not just as self-description of a woman’s milk supply, but also as a metaphor for the lives of low-income women in the US, the group least likely to breastfeed. Low-income women in the US not only have inadequate incomes as compared to the general population, but inadequate child-care, education, preventive health services, and lives saturated with violence, leaving them inadequately safe even in their own homes. Here we outline a research agenda to explore the relationship between socially determined inadequacies and the cultural logic that makes bottle feeding a preferred form of infant feeding. (190 words)
doi:10.1089/bfm.2009.0035
PMCID: PMC2763322  PMID: 19827922
3.  Inadequate: A Metaphor for the Lives of Low-Income Women? 
Breastfeeding Medicine  2009;4(Suppl 1):S-41-S-43.
Abstract
Exclusive breastfeeding of infants for the first 6 months of life with continued breastfeeding for at least 6 more months occurs only 11.9% of the time in the United States. Efforts of the past 30 years to promote optimal breastfeeding practices have had little impact. In order to create significant change in the way we feed infants in this country, we need to change the way we look at this public health issue and examine the cultural logic that makes bottle feeding the preferred choice of most U.S. women. This article analyzes the term “inadequate” not just as self-description of a woman's milk supply, but also as a metaphor for the lives of low-income women in the United States, the group least likely to breastfeed. Low-income women in the United States not only have inadequate incomes as compared to the general population, but inadequate child care, education, preventive health services, inadequate lifespans, and lives saturated with violence, leaving them inadequately safe even in their own homes. Here we outline a research agenda to explore the relationship between socially determined inadequacies and the cultural logic that makes bottle feeding a preferred form of infant feeding.
doi:10.1089/bfm.2009.0035
PMCID: PMC2763322  PMID: 19827922
4.  Perceptions of Cardiovascular Health in an Underserved Community of Deaf Adults Using American Sign Language 
Disability and Health Journal  2011;4(3):192-197.
Background
Cardiovascular disease leads in overall mortality and morbidity in the United States. Cardiovascular disparities remain high among minority and underserved groups. Deaf American Sign Language (ASL) users are an underserved and understudied group that receives little attention from researchers due to language and communication barriers. A recent ASL survey in Rochester, NY, indicated greater cardiovascular risk among Deaf participants.
Objective
To investigate risk perceptions of cardiovascular disease among Deaf ASL users, linking perceptions to features of Deaf culture and communication. This information will be used to inform future strategies to promote cardiovascular health among Deaf adults.
Methods and Participants
Four focus groups were conducted in Rochester, New York, with 22 Deaf participants in ASL. Videotaped sessions were translated and transcribed by a bilingual researcher. A team of investigators coded, analyzed and identified key themes from the data.
Main Results
Themes centered on five major domains: knowledge, barriers, facilitators, practices, and dissemination. The majority of themes focused on barriers and knowledge. Barriers included lack of health care information access due to language and communication challenges, financial constraints, and stress. Inconsistent knowledge emerged from many key areas of cardiovascular health.
Conclusions
The study outlines key themes for improving cardiovascular health knowledge and perceptions among Deaf ASL users. Findings suggest the importance of providing health educational programs and information in ASL to maximize understanding and minimize misconceptions. When caring for Deaf ASL users, providers should take extra effort to ask about cardiovascular risk factors and confirm patients’ understanding of these factors.
doi:10.1016/j.dhjo.2011.04.001
PMCID: PMC3378999  PMID: 21723526
ASL; Deaf; Deaf culture; cardiovascular health; risk perceptions
5.  Ambulance Personnel Perceptions of Near Misses and Adverse Events in Pediatric Patients 
Objective
To identify Emergency Medical Services (EMS) provider perceptions of factors that may affect the occurrence, identification, reporting, and reduction of near misses and adverse events in the pediatric EMS patient.
Methods
This was a subgroup analysis of a qualitative study examining the nature of near misses and adverse events in EMS as it relates to pediatric prehospital care. Complimentary qualitative methods of focus groups, interviews, and anonymous event reporting were used to collect results and emerging themes were identified and assigned to specific analytic domains.
Results
Eleven anonymous event reports, 17 semi-structured interviews, and 2 focus groups identified 61 total events, of which 12 (20%) were child-related. Eight (66%) of those were characterized by participants as having resulted in no injury, 2 (16%) resulted in potential injury, and 2 (16%) involved an ultimate fatality. Three analytic domains were identified which included the following five themes: reporting is uncommon, blaming errors on others, provider stress/discomfort, errors of omission, and limited training. Among perceived causes of events, participants noted factors relating to management problems specific to pediatrics, problems with procedural skill performance, medication problems/calculation errors, improper equipment size, parental interference, and omission of treatment related to providers’ discomfort with the patient’s age. Few participants spoke about errors they had themselves committed; most discussions centered on errors participants observed being made by others.
Conclusions
It appears that adverse events and near misses in the pediatric EMS environment may go unreported in a large proportion of cases. Participants attributed the occurrence of errors to the stress and anxiety produced by a lack of familiarity with pediatric patients and to a reluctance to cause pain or potential harm, as well as to inadequate practical training and experience in caring for the pediatric population. Errors of omission, rather than those of commission, were perceived to predominate. This study provides a foundation on which to base additional studies of both qualitative and quantitative nature that will shed further light on the factors contributing to the occurrence, reporting, and mitigation of adverse events and near misses in the pediatric EMS setting.
doi:10.3109/10903127.2010.497901
PMCID: PMC2932803  PMID: 20662679
Medical Error; Pediatrics; Emergency Medical Services; Ambulance
6.  Contraceptive methods and use by women aged 35 and over: A qualitative study of perspectives 
BMC Women's Health  2011;11:5.
Background
More than 30% of the pregnancies in women aged 35 and over are unintended. This paper compares perceptions about contraceptive methods and use among women with and without an unintended pregnancy after turning age 35.
Methods
Semi-structured, in-depth interviews were conducted with 17 women. They were all 35 to 49 years old, regularly menstruating, sexually active, not sterilized, not desiring a pregnancy in the near future, and at least 3 months postpartum. We purposely sampled for women who had had at least one unintended pregnancy after age 35 (n = 9) and women who did not (n = 8). We assessed partnership, views of pregnancy and motherhood, desired lifestyle, perceived advantages and disadvantages of using and obtaining currently available well-known reversible contraceptives in the U.S. ''We also assessed contraceptive methods used at any time during their reproductive years, including current method use and, if appropriate, circumstances surrounding an unintended pregnancy after age 35.'' Each interview was taped and transcribed verbatim. Data were analyzed using Grounded Theory. Analysis focused on partnership, views of pregnancy, motherhood, desired lifestyle and perceived advantages and disadvantages of various reversible contraceptive methods.
Results
The women without an unintended pregnancy after age 35 were more likely to (1) use contraceptive methods that helped treat a medical condition, (2) consider pregnancy as dangerous, or (3) express concerns about the responsibilities of motherhood. The women who experienced an unintended pregnancy after age 35 were more likely to (1) report unstable partnerships, (2) perceive themselves at lower risk of pregnancy, or (3) report past experiences with unwanted contraceptive side effects. There was a greater likelihood a woman would choose a contraceptive method if it was perceived as easy to use, accessible, affordable and had minimal side effects.
Conclusions
Women's perspective on contraceptive use after age 35 varies. Public health messages and health providers' care can help women in this age group by reviewing their fertility risks, as well as all contraceptive methods and their associated side effects. The impact of such interventions on unintended pregnancy rates in this age group should be tested in other areas of evidence-based medicine.
doi:10.1186/1472-6874-11-5
PMCID: PMC3050835  PMID: 21324194
7.  Perceptions of Cardiovascular Health in Underserved Communities 
Preventing Chronic Disease  2010;7(2):A30.
Introduction
Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions.
Methods
Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences.
Results
Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials.
Conclusion
Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.
PMCID: PMC2831784  PMID: 20158958
8.  Barrier to pneumococcal and influenza vaccinations in Black elderly communities: mistrust. 
OBJECTIVES: To understand the role of trust of medical institutions in the decision by elderly black Americans to receive pneumococcal and influenza vaccinations. DESIGN: Cross-sectional, qualitative study, using semistructured in-depth interviews. PARTICIPANTS: Twenty black Americans age > or = 65 years from two different socioeconomic groups. RESULTS: Six main themes were identified: prevention, vaccine-caused illnesses, vaccines as irrelevant to health, experience with healthcare, self-advocacy and attitudes toward childhood vaccinations. The majority of vaccinated participants viewed vaccines as a preventive measure, while the unvaccinated group viewed vaccines as irrelevant to their health. In addition, the majority of the participants in the unvaccinated group believed vaccines caused illness. Mistrust of medical institutions or the knowledge of the historical medical injustices was not a significant influence in participant's willingness to be vaccinated against pneumococcal or influenza disease. CONCLUSION: Mistrust of medical institutions was not a key concern affecting willingness to be vaccinated in this black community of elderly adults. Participant's willingness to be vaccinated was largely influenced by prior positive or negative experiences with healthcare systems.
PMCID: PMC2569746  PMID: 17052061
9.  Health Care Workers in the Dominican Republic: Self-perceived role in smoking cessation 
A Dominican Republic (DR) based multi-community trial of smoking cessation viewed health care workers (HCWs) as potential interventionists. Effectively engaging them, requires a clear understanding of their attitudes and practices regarding smoking.
A Rapid Assessment Procedure, conducted among HCWs in six economically disadvantaged communities, included physicians, nurses, other health professionals, paraprofessionals and lay workers. Attitudes and practices about smoking were consistent across the 82 HCWs and mostly reflected community views. HCWs lacked proactiveness related to smoking cessation and had a limited view of their role, attributing clients’ quitting successes to personal will. Prior cessation training was limited although interest was generally high. Material resources about smoking cessation were virtually absent.
DR HCWs’ views represented features both distinct from and common to HCWs elsewhere. Any intervention with HCWs must first raise awareness before addressing their role in smoking cessation, discussing implementation barriers and include training and materials about risks and effective interventions.
doi:10.1177/0163278709333152
PMCID: PMC3593583  PMID: 19448160
Tobacco cessation; qualitative methods; Dominican Republic

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